It was very foolish to think you could cut local authority budgets by almost 50 per cent and not see the impact on accident and emergency services, and in delayed hospital discharges, blocked beds and increased waiting times.
It was foolish to think you can take £1.9bn out of the budget for local hospitals – a third of which are already over-spending – and not provoke a financial crisis and a series of trust bankruptcies.
It was naive to think hospitals would trust local authorities to spend the money transferred to divert people from A&E and speed up discharges.
It was entirely predictable that a “spend to save” initiative would be subject to further scrutiny on exactly what would be saved when, how and by whom.
‘Relationships will be soured, as hospitals accuse local authorities of diverting funds’
Taking money from financially stressed hospitals and giving it to local authorities is unlikely to improve working relationships and pave the way to integrated services. Instead, relationships will be soured, as hospitals accuse local authorities of diverting funds, and local authorities accuse hospitals of cost shunting.
The best way to support hospitals and work towards a shift to community services is for the government to restore local authority funding for adult social services.
Age old problem
The elderly people who represent more than a third of the patients in hospital beds are the very group of people who have experience the greatest reduction in support services as a result of council budget cuts.
The one in three over-65s who suffer from dementia and their carers can best be helped by specialist day care, respite care, residential care and intensive domiciliary care funded by social services but with psycho-geriatric support.
People with chronic health conditions don’t have to be part of a hospital’s revolving door problem if there is sufficient specialist community support, including the home help and care that many local authorities have withdrawn from this group to make budget cuts.
‘People with chronic health conditions don’t have to be part of a hospital’s revolving door problem if there is sufficient specialist community support’
The crisis faced by the NHS is not just the number of elderly people living longer. People with a learning disability are also living longer: they now outlive their parents, and need help and support to live independently or in a supported living arrangement.
Cutting social service funding results in day centres being closed, reductions in respite care beds and staff to provide community support, more families in crisis, increased use of expensive private sector hospital beds and more concerns about the standards of care.
General problem
The knock-on effects for the NHS of cutting the adult social service budget can clearly be seen in mental health services. GPs report being overwhelmed. Patients report difficulty in getting appointments. A&E departments report record and rising numbers of visits.
The underfunded mental health services prioritise those discharged from psychiatric wards and those believed to be most at risk.
High levels of poverty, debt and poor housing are contributing to increasing numbers of people going to their GP with symptoms of stress, anxiety and depression.
But GPs have less time to spend with individuals and find referrals to mental health service unavailable to people with “low level” mental health problems.
Until, of course, it escalates into something more dramatic! Which you could read as a metaphor for the failure to see health and social care as a whole system, and why the government attitude to local government has made the challenges facing the NHS a whole lot worse.
Blair McPherson is an author and commentator on the public sector
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